腹腔镜探查在急腹症诊疗中的应用评价

发布时间：2018-02-01 20:49

本文关键词： 腹腔镜探查急腹症开腹探查术　出处：《西安医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的追踪分析临床急腹症患者采用不同探查方法治疗后的疗效,探讨腹腔镜检查在急腹症应用中的优越性,为临床上处理急腹症提供准确详实的参考依据。方法选择西安高新医院2010年6月至2016年6月间的250例急腹症患者,入组标准:急性腹痛入院,查体存在程度不一的腹部压痛、反跳痛等表现,相关检查手段未明确诊断(血常规,生化,血淀粉酶,腹平片,腹部B超,腹部CT),除外血流动力学不稳定、腹腔内大出血、疑有严重复合伤或腹膜后脏器损伤、术前经非手术手段已明确诊断者、腹腔镜术中改为开腹探查术者,其中男性患者有146例,女性患者有104例,患者年龄区间为21~68岁,平均年龄为(45.46±9.35)岁;患者发病后来院时间为6~71 h之间;以上250例患者随机分为试验组和对照组,其中试验组140例对照组110例,试验组采取电子腹腔镜探查术,对照组采取剖腹探查术。以上两组患者根据试验要求采用腹腔镜和开腹探查后观察2组患者的确诊率、手术切口长度、手术出血量、置管率、置管留置时间、手术时间、抗生素使用时间、术后腹痛症状消失时间、肛门排气排便时间、进食时间、住院时间差异及其切口感染率,将以上数据进行分析,证明腹腔镜探查在急腹症诊治中的优势。实验数据采用SPSS 18.0软件进行统计分析,计量资料采取(?x±s)表示,组间比较采用t检验;计数资料均用n/%表示,组间采用χ2检验进行比较。P0.05代表差异具统计学意义。结果250例急腹症患者,包括:急性阑尾炎和慢性阑尾炎急性发作122例(48.8%),胃十二指肠溃疡穿孔43例(17.2%),急性结石性胆囊炎和慢性结石性胆囊炎急性发作67例(26.8%),粘连性肠梗阻18例(7.2%)。试验组140例均于腹腔镜探查下明确诊断并于腔镜下完成手术,无1例死亡病例;对照组110例均行传统剖腹探查术,两组患者确诊率的差异无统计学意义(P0.05),但手术切口长度、手术出血量、置管率、置管时间、手术时间、抗生素使用时间、术后腹痛消失时间、肛门排气排便时间、进食时间、住院时间及切口感染率的差异均有统计学意义(P0.05)。结论(1)腹腔镜技术应用于急腹症探查,能及早明确诊断,且能避免不必要的开腹手术,从而避免病情的延误,改善患者预后;(2)急腹症患者应用腹腔镜技术进行探查手术,可将诊断、治疗同步进行,兼具诊断与治疗的双重作用;(3)腹腔镜探查在急腹症诊治中可充分发挥腹腔镜视野开阔的特点,在直视下进行操作,有利于彻底冲洗腹腔内脓液、血液、胆汁及肠内容物,再在各腔隙陷窝放置引流后,有助于减少术后感染和肠粘连的发生;(4)腹腔镜探查应用于急腹症诊治造成的伤口小,腹腔镜下操作对于腹腔内组织的干扰较小,对组织器官损伤较轻,术后较少发生肠粘连,患者术后胃肠道功能很快得以恢复,减少了住院时间。
[Abstract]:Objective to analyze the curative effect of different exploration methods in patients with acute abdomen and discuss the superiority of laparoscopy in the application of acute abdomen. Methods 250 patients with acute abdomen were selected from June 2010 to June 2016 in Xi'an High Tech Hospital and admitted to hospital with acute abdominal pain. Physical examination of varying degrees of abdominal tenderness, rebound pain and other manifestations, the relevant examination methods are not clear diagnosis (blood routine, biochemical, blood amylase, abdominal plain film, abdominal B ultrasound, abdominal CTT). Except hemodynamic instability, intraperitoneal hemorrhage, suspected serious complex injury or retroperitoneal organ injury, preoperative non-operative means have been clearly diagnosed, laparoscopic surgery instead of laparotomy exploration. There were 146 male patients and 104 female patients. The age range of the patients was 21 68.The average age was 45.46 卤9.35 years. The time of the patient coming to hospital after onset was between 61h and 71h. The above 250 patients were randomly divided into the experimental group and the control group, of which 140 cases in the experimental group and 110 cases in the control group. In the control group, laparoscopy and laparotomy were used to observe the diagnosis rate, incision length, bleeding volume, catheterization rate and indwelling time after laparoscopy and laparotomy. Operation time, antibiotic use time, postoperative abdominal pain symptom disappearance time, anal exhaust defecation time, feeding time, hospitalization time and incision infection rate were analyzed. To prove the advantage of laparoscopic exploration in the diagnosis and treatment of acute abdomen. The experimental data were analyzed by SPSS 18.0 software. X 卤s), t test was used for comparison between groups. Counting data were expressed as n /%, 蠂 2 test was used between the two groups to compare. P05 was statistically significant. Results 250 patients with acute abdomen. These included acute appendicitis and chronic appendicitis in 122 patients with acute appendicitis (48.8%) and perforation of gastroduodenal ulcer (43 cases). Acute gallstone cholecystitis and chronic calculous cholecystitis in 67 patients with acute attack. There were 18 cases of adhesive intestinal obstruction. 140 cases of experimental group were definitely diagnosed by laparoscopy and operated under laparoscope, none of them died. There was no significant difference in the diagnosis rate between the two groups (P 0.05), but the length of incision, the amount of bleeding, the rate of catheterization, the time of catheterization and the time of operation. Time of antibiotic use, time of disappearance of abdominal pain after operation, time of anal exhaust and defecation, time of eating. The difference of hospitalization time and incision infection rate was statistically significant (P 0.05) conclusion Laparoscopic technique can be used in the exploration of acute abdomen, can be diagnosed as early as possible, and can avoid unnecessary open surgery. In order to avoid the delay of the disease and improve the prognosis of patients; (2) Laparoscopic technique is used to explore the patients with acute abdomen. The diagnosis and treatment can be carried out simultaneously, which has the dual function of diagnosis and treatment. Laparoscopic exploration in the diagnosis and treatment of acute abdomen can give full play to the characteristics of open laparoscopic visual field, under the direct vision of the operation, is conducive to the thorough washing of abdominal pus, blood, bile and intestinal contents. After drainage was placed in the lacunar lacunae, it was helpful to reduce postoperative infection and intestinal adhesion. 4) Laparoscopic exploration was used in diagnosis and treatment of acute abdomen, the wound caused by laparoscopy was small, the operation under laparoscope had less interference to abdominal tissue, less injury to tissues and organs, and less intestinal adhesion after operation. Postoperative gastrointestinal function recovered quickly, reducing hospital stay.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.1

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